Pictorial essay: imaging findings following Y90 radiation segmentectomy for hepatocellular carcinoma

Ronald A. Mora, Rehan Ali, Ahmed Gabr, Nadine Abouchaleh, Ali Al Asadi, Joseph Ralph Kallini, Frank H. Miller, Vahid Yaghmai, Samdeep Mouli, Bartley Thornburg, Kush Desai, Ahsun Riaz, Robert J. Lewandowski, Riad Salem*

*Corresponding author for this work

Research output: Contribution to journalReview article

5 Scopus citations

Abstract

Transarterial radioembolization is a novel therapy that has gained rapid clinical acceptance for the treatment of hepatocellular carcinoma (HCC). Segmental radioembolization [also termed radiation segmentectomy (RS)] is a technique that can deliver high doses (> 190 Gy) of radiation selectively to the hepatic segment(s) containing the tumor. The aim of this comprehensive review is to provide an illustrative summary of the most relevant imaging findings encountered after radiation segmentectomy. A 62-patient cohort of Child–Pugh A patients with solitary HCC < 5 cm in size was identified. A comprehensive retrospective imaging review was done by interventional radiology staff at our institution. Important imaging findings were reported and illustrated in a descriptive account. For the purposes of completeness, specific patients outside our initial cohort with unique educational imaging features that also underwent segmentectomy were included in this pictorial essay. This review shows that response assessment after RS requires a learning curve with common drawbacks that can lead to false-positive interpretations and secondary unnecessary treatments. It is important to recognize that treatment responses and pathological changes both are time dependent. Findings such as benign geographical enhancement and initial benign pathological enhancement can easily be misinterpreted. Capsular retraction and segmental atrophy are some other examples of unique post-RS response that are not seen in any other treatment.

Original languageEnglish (US)
Pages (from-to)1723-1738
Number of pages16
JournalAbdominal Radiology
Volume43
Issue number7
DOIs
StatePublished - Jul 1 2018

Keywords

  • European Association for the Study of the Liver (EASL)
  • Hepatocellular carcinoma (HCC)
  • Radiation segmentectomy
  • Radioembolization
  • World Health Organization (WHO)

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Gastroenterology
  • Urology

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